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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206770
Report Date: 02/27/2023
Date Signed: 02/28/2023 08:05:21 AM


Document Has Been Signed on 02/28/2023 08:05 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:POINTE AT SUMMIT HILLS, THEFACILITY NUMBER:
157206770
ADMINISTRATOR:BENNY FARILLASFACILITY TYPE:
740
ADDRESS:4501 UPLAND POINT DRIVETELEPHONE:
(661) 447-4800
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY:102CENSUS: 53DATE:
02/27/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
06:30 PM
MET WITH:Sheree Addison, Acting Administrator,TIME COMPLETED:
08:30 PM
NARRATIVE
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On 02/27/23, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct an unannounced 10 day site visit. LPA was greeted by receptionist, stated the purpose and was allowed entry into the facility. COVID precautionary measures were taken at the time of entry.

LPA toured both floors of the facility. Both floors include the memory care unit of the facility. There are currently 39 Residents living in Assisted Living and 14 resident in the Memory Care unit. During the course of the visit, LPA was approached by a family member of Resident R1. Family member was very upset that R1 has run out of one of their daily medication, 2 days ago, and facility has not refilled.

LPA toured the medication room, interviewed Staff S3 and observed R1's Centrally Stored Medication Records. Records show R1 has been without their prescribed medication for 2 days and is supposed to have 5/6 doses a day. This resulted in R1 missing a minimum of 15 doses of their prescribed medication.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D. If not corrected, the violation will have a direct and immediate risk to the health, safety, or personal rights of clients in care. A plan of correction with a due date of 02/28/23 was developed by Acting Administrator and reviewed with LPA.

An exit interview was conducted with Acting Administrator. A copy of this report and appeal rights were discussed and provided.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/28/2023 08:05 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: POINTE AT SUMMIT HILLS, THE
FACILITY NUMBER: 157206770

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/28/2023
Section Cited

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87465 Incidental Medical and Dental Care
(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:
(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.
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Acting Administrator (AA) will provide LPA with documentation evidencing prescription was ordered by POC date of 02/28/23.
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This requirement was not met as evidenced my LPAs interview with R1's responsible party, review of centrally stored medication and destruction records showing medication ran out 2 days ago and R1 had been without medication.
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AA will conduct staff training 02/28/23 with all Med techs. Training will include new policy procedures on ordering refills in a timely manner and the documentation of medications dispersed by 03/10/23. AA will send proof of training for all staff.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2023
LIC809 (FAS) - (06/04)
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